CONCORD — Expanding Medicaid eligibility through the Affordable Care Act will be contingent on federal officials approving the use of private insurance if lawmakers adopt a draft proposal from the commission studying the issue.
The Commission to Study Medicaid Expansion voted 6-2, with one member abstaining, to approve a plan that would have the state expand Medicaid eligibility in order to maximize the available federal money, while using private insurance to cover as many newly eligible people as possible.
State officials estimate that about 49,000 low-income adults will be eligible for the Medicaid rolls under expansion; the state’s health care providers would receive $2.4 billion over the next seven years.
On Tuesday, the committee decided its final question: when should expansion begin.
Under the provision approved on an 8-1 vote, lawmakers meeting in special session this fall would direct state health officials to apply for the waiver allowing the state to expand the Health Insurance Premium Payment program, which pays premiums for those on their employers’ health plans.
State officials believe the waiver could be approved before Jan. 1, which is the earliest date federal money is available to pay 100 percent of the cost of those who qualify under expansion. However, if the waiver is not approved, expansion would not go forward.
“This gets us started and into the system and working on moving forward with the whole process and not losing any federal funding,” said Rep. Thomas Sherman, R-Rye, who proposed the framework of the commission’s plan.
Commission member Sen. Nancy Stiles, R-Hampton, proposed making expansion contingent on the HIPP waiver.
“I do believe the Legislature can get to yes on expanding health insurance coverage in some form,” Stiles said, “and I’m encouraged by the commission’s openness to the use of private insurance to cover some of those who will become newly eligible under such an expansion.”
GOP response in Senate
Convincing the Republican-controlled Senate — which blocked expansion through the budget process last spring — is crucial to expansion as both Gov. Maggie Hassan and the Democratically controlled House support expanding eligibility.
After the commission’s vote Tuesday, Senate President Chuck Morse, R-Salem, called the plan a good starting point.
“I was pleased the commission expressed support for providing access to private insurance for low-income New Hampshire citizens as a means of reducing the number of uninsured in our state,” Morse said. “That provision is a good starting point toward finding common ground, and I look forward to the beginning of the legislative process that will hopefully bring us full-circle to a bi-partisan New Hampshire solution.”
Last week Morse said he would not impede a special session if Hassan calls lawmakers back to vote on expansion and said he is willing to negotiate with the governor.
Worries about cost
The commission has expressed concerns the state may not be able to afford expansion if program costs exceed estimates, or if the federal government reneges on its financial commitment or increases benefits, but failed to agree on how the state should extricate itself from the program if any of those occur. The commission did agree to a six-month window for the legislature to reauthorize expansion if federal support decreases, allowing the state to withdraw from expansion.
Several commissioners cautioned future costs may require a major financial commitment the state may not be able to afford, but the majority rejected two proposals on 5-4 votes: one that would automatically end the state’s participation if program costs exceed 10 percent of estimates and the another that would cap the program at 60,000 people.
“If you don’t put in triggers, it takes three to tango,” said Rep. Neal Kurk, R-Weare, who made the proposals. “If you put in triggers, it takes one to say I’m not dancing.”
But opponents of the triggers noted with the federal government paying 100 percent of the cost for the newly eligible people, the state will have several years of information to review and then decide how to adjust the program before the state has to begin contributing.
“We have the opportunity to collect (data) for two years,” Sherman said. “We can get back on track using real hard information, not talking about the outlining pieces we are all concerned about.”
Oct. 15 deadline
The commission has worked since July and now faces an Oct. 15 deadline to make recommendations to the legislature.
Last week the committee agreed expansion should include adults below 138 percent of the federal poverty level. Members also agreed those eligible for Medicaid with employer-supplied health insurance must participate in the Health Insurance Premium Payment program.
The commission agreed to allow those between 100 to 138 percent of the poverty level to purchase policies through the health insurance exchange paid for by Medicaid funds. The program would be voluntary, so the state would not need a waiver.
The commission also agreed the benefits under expansion should be the 10 essential services which must be offered in all plans sold on the exchange, as well as mental health and substance abuse treatment coverage, which are required under the ACA.
New Hampshire is one of eight states who have yet to make a decision on whether to expand Medicaid eligibility.
“Chasing unicorns is what so much of this report is to many of us,” said Sen. Andy Sanborn, R-Bedford, who opposed the plan and has been a vocal critic of expansion.
The commission meets Tuesday at 11 a.m. to review the final report.